Describing resident physician productivity in a Canadian academic emergency department.

PURPOSE: This cohort study aimed to investigate resident physician productivity in an academic emergency department (ED) and assess the impact of longitudinal coaching relationships known as clinical coaching teams and co-learners (medical students) on resident productivity. METHODS: Data from patient visits to two academic EDs in Ottawa, Canada between April 2022 and March 2023 were analyzed. The attending physician schedule, learner arrangements, and patient ED treatment team information were collected. The presence or absence of clinical coaching teams was also recorded. Mean productivity, measured as patients per hour, was calculated for different shifts and learner arrangements. Linear regression and paired t tests were performed for analysis across ambulatory and non-ambulatory settings, with a focus on productivity differences across residents' training programs and level of training. RESULTS: A total of 142,386 ED visits were included in the analysis across 8161 attending physician shifts. Resident productivity increased with each year of training, with Royal College of Physicians and Surgeons of Canada emergency medicine residents being the most productive by year 5. There was no significant difference in productivity between residents on clinical coaching team shifts compared to non-clinical coaching team shifts. Productivity decreased slightly when residents worked with medical students as co-learners. There was no significant relationship between the difference in productivity on shifts with and without a medical student and year of training. CONCLUSIONS: This study is the first of its kind to describe resident physician productivity in a Canadian emergency department. The results of this study demonstrate that resident physician productivity improves with seniority, and that co-learners and clinical coaching teams do not significantly impact productivity. This information will be useful to program directors and residents to help set realistic expectations around productivity and to ED physician leads in planning service delivery for patients in the context of a training program.

RéSUMé: BUT: Cette étude de cohorte visait à étudier la productivité des médecins résidents dans un service d'urgence universitaire (DE) et à évaluer l'impact des relations longitudinales de coaching connues sous le nom d'équipes de coaching clinique et de co-apprenants (étudiants en médecine) sur la productivité des résidents. MéTHODES: Les données des visites de patients à deux ED universitaires à Ottawa, au Canada, entre avril 2022 et mars 2023 ont été analysées. Le calendrier des médecins traitants, les arrangements avec les apprenants et l'équipe de traitement des patients en DE ont été recueillis. La présence ou l'absence d'équipes de coaching clinique a également été enregistrée. La productivité moyenne, mesurée en patients par heure, a été calculée pour les différents postes et arrangements des apprenants. Une régression linéaire et des tests T jumelés ont été effectués pour l'analyse dans les milieux ambulatoires et non ambulatoires, en mettant l'accent sur les différences de productivité entre les programmes de formation des résidents et leur niveau de formation. RéSULTATS: Un total de 142 386 visites à la DE ont été incluses dans l'analyse pour 8161 quarts de travail des médecins traitants. La productivité des résidents augmente à chaque année de formation, Les résidents en médecine d'urgence du Collège royal des médecins et chirurgiens du Canada étaient les plus productifs au cours de la 5e année. Il n'y avait pas de différence significative dans la productivité entre les résidents qui travaillaient en équipe d'encadrement clinique comparativement aux équipes d'encadrement non cliniques. La productivité a légèrement diminué lorsque les résidents ont travaillé avec des étudiants en médecine comme coapprenants. Il n'y avait pas de relation significative entre la différence de productivité entre les quarts de travail avec et sans étudiant en médecine et l'année de formation. CONCLUSION: Cette étude est la première du genre à décrire la productivité des médecins résidents dans un service d'urgence canadien. Les résultats de cette étude démontrent que la productivité des médecins résidents s'améliore avec l'ancienneté et que les coapprenants et les équipes d'encadrement clinique n'ont pas d'incidence importante sur la productivité. Ces renseignements seront utiles aux directeurs de programme et aux résidents pour établir des attentes réalistes en matière de productivité et aux médecins chefs de file en DE pour planifier la prestation de services aux patients dans le contexte d'un programme de formation.

The impact of various learner arrangements on emergency department staff productivity.

PURPOSE: This study aimed to examine how different learner arrangements affect the number of patients seen per hour by staff emergency physicians in ambulatory and non-ambulatory zones of two tertiary teaching hospitals in Ottawa, Canada. METHODS: This was a retrospective cohort study analyzing all emergency department (ED) shifts at the Civic and General Campus EDs of The Ottawa Hospital from April 2022 to March 2023. Data collected included shift type (ambulatory or non-ambulatory), learner arrangement, and number of patients seen per hour. Descriptive statistics and two-sample, two-tailed t tests to analyze the relationship between patients seen per hour and learner arrangements. RESULTS: We analyzed 8161 shifts over the study period, including 5233 in ambulatory care and 2928 in non-ambulatory care areas. Among ambulatory care shifts, the average number of patients seen per hour was 2.1 (95% CI 2.1-2.1) when working alone, 1.9 (1.9-2.0, p < 0.001) with a medical student, 2.1 (2.1-2.2, p = 0.20) with a junior resident, 2.6 (2.5-2.6, p < 0.001) with a senior resident, 2.1 (2.1-2.2, p = 0.33) with a junior resident and a medical student, and 2.6 (2.5-2.7, p < 0.001) with a senior resident and a medical student. In non-ambulatory care shifts, the average number of patients seen per hour was 1.4 (95% CI 1.3-1.5) when working alone (122 shifts, 4%), 1.4 (1.4-1.5, p = 0.63) with a medical student (85 shifts, 3%), 1.5 (1.5-1.5, p = 0.02) with a junior resident (1,013 shifts, 35%), 1.8 (1.7-1.8, p < 0.001) with a senior resident (682 shifts, 23%), 1.6 (1.5-1.6, p < 0.001) with a junior resident and a medical student (683 shifts, 23%), and 1.8 (1.7-1.8, p < 0.001) with a senior resident and a medical student (343 shifts, 12%). CONCLUSION: This study highlights the significant impact that learner arrangements have on staff physician productivity in the ED. These findings underscore the importance of strategic scheduling to optimize patient throughput.

RéSUMé: BUT: Cette étude visait à examiner comment les différents arrangements des apprenants influent sur le nombre de patients vus par heure par les médecins urgentistes dans les zones ambulatoires et non ambulatoires de deux hôpitaux universitaires tertiaires d'Ottawa, au Canada. MéTHODES: Il s'agissait d'une étude de cohorte rétrospective qui analysait tous les quarts de travail des services d'urgence (DE) aux DPE du campus civique et général de l'Hôpital d'Ottawa d'avril 2022 à mars 2023. Les données recueillies comprenaient le type de quart (ambulatoire ou non), l'arrangement des apprenants et le nombre de patients vus par heure. Statistiques descriptives et tests en t à deux échantillons et à deux queues pour analyser la relation entre les patients vus par heure et les arrangements de l'apprenant. RéSULTATS: Nous avons analysé 8 161 postes de travail sur la période étudiée, dont 5 233 dans les services ambulatoires et 2 928 dans les services non ambulatoires. Parmi les quarts de soins ambulatoires, le nombre moyen de patients vus par heure était de 2.1 (IC à 95 % 2.1­2.1) lorsqu'ils travaillaient seuls, de 1.9 (1.9­2.0, p<0.001) avec un étudiant en médecine, de 2.1 (2.1­2.2, p = 0.20) avec un jeune résident, de 2.6 (2.5­2.6, p<0.001) avec un senior résident, de 2.1 (2.1­2.2, p = 0.33) avec un jeune résident et un étudiant en médecine, et 2.6 (2.5­2.7, p<0.001) avec un résident sénior et un étudiant en médecine. Dans les quarts de travail non ambulatoires, le nombre moyen de patients vus par heure était de 1.4 (IC à 95 % 1.3­1.5) lorsqu'ils travaillaient seuls (122 quarts, 4 %), 1.4 (1.4­1.5, p = 0.63) avec un étudiant en médecine (85 quarts, 3 %), 1.5 (1.5­1.5, p = 0.02) avec un jeune résident (1 013 quarts, 35 %), 1.8 (1.7­1.8, p < 0.001) avec un résident aîné (682 quarts de travail, 23 %), 1.6 (1.5­1.6, p < 0.001) avec un résident junior et un étudiant en médecine (683 quarts de travail, 23 %), et 1.8 (1.7­1.8, p < 0.001) avec un résident aîné et un étudiant en médecine (343 quarts de travail, 12 %). CONCLUSION: Cette étude met en évidence l'impact important que les arrangements avec les apprenants ont sur la productivité des médecins du personnel dans le DE. Ces résultats soulignent l'importance de la planification stratégique pour optimiser le débit des patients.

Environmental influences and individual characteristics that affect learner-centered teaching practices.

Research-based teaching practices can improve student learning outcomes in a variety of complex educational environments. The implementation of learner-centered teaching practices in STEM can both benefit from or be constrained by different factors related to individual instructors and the teaching environment. Additionally, we know little of how the instructional climate varies across institutions and how this climate affects teaching practices. Our study sought to examine the relative importance of environmental influences and individual characteristics on learner-centered teaching practices across institutions. We also assessed differences in our study population and departmental climate for 35 US higher education institutions across the country. We found that self-efficacy in teaching and professional development exert a strong influence on faculty teaching practices in biology. While departmental climate did not emerge as a significant predictor of teaching practices, there was consistently low support for teaching, and institution size was negatively correlated with leadership and evaluation of effective teaching. We also found that intensive professional development programs, such as the Faculty Institutes for Reforming Science Teaching IV program, may prepare instructors to teach learner-centered courses in different collegial teaching climates. Our results suggest that through cultivating self-efficacy and participating in iterative professional development, instructors can implement effective teaching practices in a variety of institutional environments.

Early-career faculty practice learner-centered teaching up to 9 years after postdoctoral professional development.

The goal of STEM professional development for teaching is that participants continue to practice what they learn in the long term. However, we do not know if the outcomes are achieved and ultimately persist. We tracked postdoctoral participants from the Faculty Institutes for Reforming Science Teaching (FIRST) IV program into their current positions as early-career biology faculty. We assessed their teaching approaches, practices, and student perceptions of the learning environment over 6 to 9 years after finishing the program. Simultaneously, we evaluated paired faculty in the same departments. We found that professional development outcomes persisted over time and across a career transition. FIRST IV faculty maintained their learner-centered practices and were more learner-centered than their peers. Last, we found that teaching approaches were correlated with teaching practices in all faculty participants. These results provide evidence for the success of the FIRST IV program and the long-term persistence of professional development outcomes.

A Problem-Sorting Task Detects Changes in Undergraduate Biological Expertise over a Single Semester.

Calls for undergraduate biology reform share similar goals: to produce people who can organize, use, connect, and communicate about biological knowledge. Achieving these goals requires students to gain disciplinary expertise. Experts organize, access, and apply disciplinary knowledge differently than novices, and expertise is measurable. By asking introductory biology students to sort biological problems, we investigated whether they changed how they organized and linked biological ideas over one semester of introductory biology. We administered the Biology Card Sorting Task to 751 students enrolled in their first or second introductory biology course focusing on either cellular-molecular or organismal-population topics, under structured or unstructured sorting conditions. Students used a combination of superficial, deep, and yet-uncharacterized ways of organizing and connecting biological knowledge. In some cases, this translated to more expert-like ways of organizing knowledge over a single semester, best predicted by whether students were enrolled in their first or second semester of biology and by the sorting condition completed. In addition to illuminating differences between novices and experts, our results show that card sorting is a robust way of detecting changes in novices' biological expertise-even in heterogeneous populations of novice biology students over the time span of a single semester.

Assessing faculty professional development in STEM higher education: Sustainability of outcomes.

We tested the effectiveness of Faculty Institutes for Reforming Science Teaching IV (FIRST), a professional development program for postdoctoral scholars, by conducting a study of program alumni. Faculty professional development programs are critical components of efforts to improve teaching and learning in the STEM (Science, Technology, Engineering, and Mathematics) disciplines, but reliable evidence of the sustained impacts of these programs is lacking. We used a paired design in which we matched a FIRST alumnus employed in a tenure-track position with a non-FIRST faculty member at the same institution. The members of a pair taught courses that were of similar size and level. To determine whether teaching practices of FIRST participants were more learner-centered than those of non-FIRST faculty, we compared faculty perceptions of their teaching strategies, perceptions of environmental factors that influence teaching, and actual teaching practice. Non-FIRST and FIRST faculty reported similar perceptions of their teaching strategies and teaching environment. FIRST faculty reported using active learning and interactive engagement in lecture sessions more frequently compared with non-FIRST faculty. Ratings from external reviewers also documented that FIRST faculty taught class sessions that were learner-centered, contrasting with the teacher-centered class sessions of most non-FIRST faculty. Despite marked differences in teaching practice, FIRST and non-FIRST participants used assessments that targeted lower-level cognitive skills. Our study demonstrated the effectiveness of the FIRST program and the empirical utility of comparison groups, where groups are well matched and controlled for contextual variables (for example, departments), for evaluating the effectiveness of professional development for subsequent teaching practices.

Breaking the cycle: future faculty begin teaching with learner-centered strategies after professional development.

The availability of reliable evidence for teaching practices after professional development is limited across science, technology, engineering, and mathematics disciplines, making the identification of professional development "best practices" and effective models for change difficult. We aimed to determine the extent to which postdoctoral fellows (i.e., future biology faculty) believed in and implemented evidence-based pedagogies after completion of a 2-yr professional development program, Faculty Institutes for Reforming Science Teaching (FIRST IV). Postdocs (PDs) attended a 2-yr training program during which they completed self-report assessments of their beliefs about teaching and gains in pedagogical knowledge and experience, and they provided copies of class assessments and video recordings of their teaching. The PDs reported greater use of learner-centered compared with teacher-centered strategies. These data were consistent with the results of expert reviews of teaching videos. The majority of PDs (86%) received video ratings that documented active engagement of students and implementation of learner-centered classrooms. Despite practice of higher-level cognition in class sessions, the items used by the PDs on their assessments of learning focused on lower-level cognitive skills. We attributed the high success of the FIRST IV program to our focus on inexperienced teachers, an iterative process of teaching practice and reflection, and development of and teaching a full course.

I WAS HERE: young mothers who have experienced homelessness use Photovoice and participatory qualitative analysis to demonstrate strengths and assets.

Inspired by Photovoice, a participatory research methodology, I WAS HERE was a photoblogging workshop in Toronto, Canada, for young mothers who, when they joined, were either homeless or had past experience of homelessness. A participatory qualitative analysis process was developed to support workshop participants in collectively conducting qualitative analysis on a selection of their photoblogs exploring how they view their lives. Five mothers engaged in the participatory qualitative analysis process to categorize their photoblogs into themes. Participants selected over 70 of their personal photoblogs, discussed the meaning of their photoblogs, and categorized them into qualitative themes. One of the mothers continued work on the research by contributing to the write-up of the themes for publication. Participants, through the reflective dialogue, developed nine themes from the photoblogs that describe how they experience motherhood. The resulting nine themes were as follows: 'Family', 'Reality Check', 'Sacrifice for Positive Change', 'Support', 'Guidance', 'Growth and Transition', 'Proud of Becoming/Being a Mother', 'Passing on/Teaching Values' and 'Cherished Moments/Reward for Being a Mother'. These themes illustrate the satisfaction that comes from motherhood, strengths and goals for the future, and the desire for support and guidance. The themes developed from this participatory analysis illustrate that young mothers have a positive view of themselves and their ability to be mothers. This constructive view of young mothers provides an alternative to the negative stereotypes commonly attributed to them. This paper also discusses the strengths and challenges of using a participatory analysis approach. As a research methodology, incorporating procedures for participatory qualitative analysis into the Photovoice process provides an effective mechanism to meaningfully engage participants in qualitative analysis. From a health promotion perspective, using the participatory analysis process expanded the Photovoice methodology to facilitate self-reflection and an empowering collective dialogue among a group of women whose strengths and assets are rarely showcased.

The other half of the story: effect size analysis in quantitative research.

Statistical significance testing is the cornerstone of quantitative research, but studies that fail to report measures of effect size are potentially missing a robust part of the analysis. We provide a rationale for why effect size measures should be included in quantitative discipline-based education research. Examples from both biological and educational research demonstrate the utility of effect size for evaluating practical significance. We also provide details about some effect size indices that are paired with common statistical significance tests used in educational research and offer general suggestions for interpreting effect size measures. Finally, we discuss some inherent limitations of effect size measures and provide further recommendations about reporting confidence intervals.

Stress hormones mediate predator-induced phenotypic plasticity in amphibian tadpoles.

Amphibian tadpoles display extensive anti-predator phenotypic plasticity, reducing locomotory activity and, with chronic predator exposure, developing relatively smaller trunks and larger tails. In many vertebrates, predator exposure alters activity of the neuroendocrine stress axis. We investigated predator-induced effects on stress hormone production and the mechanistic link to anti-predator defences in Rana sylvatica tadpoles. Whole-body corticosterone (CORT) content was positively correlated with predator biomass in natural ponds. Exposure to caged predators in mesocosms caused a reduction in CORT by 4 hours, but increased CORT after 4 days. Tadpoles chronically exposed to exogenous CORT developed larger tails relative to their trunks, matching morphological changes induced by predator chemical cue; this predator effect was blocked by the corticosteroid biosynthesis inhibitor metyrapone. Tadpole tail explants treated in vitro with CORT increased tissue weight, suggesting that CORT acts directly on the tail. Short-term treatment of tadpoles with CORT increased predation mortality, likely due to increased locomotory activity. However, long-term CORT treatment enhanced survivorship, likely due to induced morphology. Our findings support the hypothesis that tadpole physiological and behavioural/morphological responses to predation are causally interrelated. Tadpoles initially suppress CORT and behaviour to avoid capture, but increase CORT with longer exposure, inducing adaptive phenotypic changes.

Consequences of intraspecific niche variation: phenotypic similarity increases competition among recently metamorphosed frogs.

Phenotype is often correlated with resource use, which suggests that as phenotypic variation in a population increases, intraspecific competition will decrease. However, few studies have experimentally tested the prediction that increased intraspecific phenotypic variation leads to reduced competitive effects (e.g., on growth rate, survival or reproductive rate). We investigated this prediction with two experiments on wood frogs (Rana sylvatica). In the first experiment, we found that a frog's size was positively correlated with the size of its preferred prey, indicating that the feeding niche of the frogs changed with size. In the second experiment, we used an experimental design in which we held the initial mass of "focal" frogs constant, but varied the initial mass of their competitors. We found a significant quadratic effect of the average mass of competitors: focal frog growth was lowest when raised with similar-sized competitors, and highest when raised with competitors that were larger or smaller. Our results demonstrate that growth rates increase (i.e., competitive intensity decreases) when individuals are less similar to other members of the population and exhibit less overlap in resource use. Thus, changes in the amount of phenotypic variation in a population may ultimately affect population-level processes, such as population growth rate and extinction risk.